September 10, 2009

I watched the big speech last night, but didn't live-blog. But now that the text is available, let me locate the few things that I felt at the time I would have live-blogged if I'd been live-blogging and see how they strike me in the cool light of day:

Well the time for bickering is over. The time for games has passed. Now is the season for action.

Why? This is just a raw pronouncement, and he's tried to call time before, including back when the hot debate was only beginning. What I hear is: Shut up. It irks me. It makes me want to make trouble for him. He never encouraged debate. But the debate grew in spite of that. He keeps looking back on what he didn't want at all and says now, that's enough of that.

[I]f you are among the hundreds of millions of Americans who already have health insurance through your job, Medicare, Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have. Let me repeat this: nothing in our plan requires you to change what you have.

I get it. Nothing will require anything of me if I have what I like (and I do). But if you change the structure of the insurance market, my insurance company may not survive or it may be forced to change. Then how do I keep what I have? What I have now may not exist in the future. This is why I do not feel secure.

What this plan will do is to make the insurance you have work better for you.

But I like my plan now. You admit you're going to change it.

Under this plan, it will be against the law for insurance companies to deny you coverage because of a pre-existing condition.

Not just me, but anybody. The health insurance business will have to change. I understand the good of helping people with medical conditions, but I wonder what it will do to the private business to suddenly change this.

As soon as I sign this bill, it will be against the law for insurance companies to drop your coverage when you get sick or water it down when you need it most.

And that will change the economics of insurance. Why will that work? What if companies go out of business when you deprive them of the ways they've come up with to be profitable? I'm afraid making the insurance business unprofitable is completely acceptable to you, because you don't mind if in the end government takes over everything. It's what you would do now if you could, isn't it?

They will no longer be able to place some arbitrary cap on the amount of coverage you can receive in a given year or a lifetime. We will place a limit on how much you can be charged for out-of-pocket expenses, because in the United States of America, no one should go broke because they get sick. And insurance companies will be required to cover, with no extra charge, routine checkups and preventive care, like mammograms and colonoscopies – because there's no reason we shouldn't be catching diseases like breast cancer and colon cancer before they get worse. That makes sense, it saves money, and it saves lives.

It will cost less? I just don't believe that prevention and early detection will perform the necessary magic. And who will provide all this extra care?

That's what Americans who have health insurance can expect from this plan – more security and stability.

Security and stability? That sounds nice, but I don't feel... secure about it.

Obama goes on to describe the insurance exchange that will improve the market for people who don't now have health insurance and the tax credits that will help "individuals and small businesses who still cannot afford" insurance. I don't know who qualifies for these credits, but that is a loss of tax revenue, and the burden must fall on the rest of us, some of whom are going to be forced to buy something we haven't been buying yet. There is some kind of a squeeze on people in the middle. But presumably, we are already paying for these people when they do go to emergency rooms, and getting everyone covered, even if some don't pay, will spread the costs more widely.

[The] exchange will take effect in four years, which will give us time to do it right.

And him time to get re-elected.

Next, Obama explains why everyone will be required to buy health insurance. It's "irresponsible" not to. So all-encompassing care is recast as personal responsibility. But the real point is economic: The new system — requiring insurance companies to cover pre-existing conditions and not to charge different rates even for those who begin with very expensive medical needs — won't work unless all the healthy people are forced to join and pay in much more than they are taking out. They can't be allowed to game the system, keep all their money, and then opt in to cheap insurance when they start needing reimbursements.

Where will all these people get the money to buy insurance? We're told that some people and businesses will get "a hardship waiver," but we aren't told where the cut-off point is.

While there remain some significant details to be ironed out...

This got a huge laugh at the time. It was the biggest laugh of the night, I think.

... I believe a broad consensus exists for the aspects of the plan I just outlined: consumer protections for those with insurance, an exchange that allows individuals and small businesses to purchase affordable coverage, and a requirement that people who can afford insurance get insurance.

And I have no doubt that these reforms would greatly benefit Americans from all walks of life, as well as the economy as a whole.

At this point, last night, I felt some hope, but not knowing what the details are going to be, I was also pretty suspicious. The next part of the speech, however, attacked his critics and felt like nasty attack on ordinary people who have legitimate doubts and whose criticisms were what pushed him into the more moderate position that was giving me hope.

Some of people's concerns have grown out of bogus claims spread by those whose only agenda is to kill reform at any cost. The best example is the claim, made not just by radio and cable talk show hosts, but prominent politicians, that we plan to set up panels of bureaucrats with the power to kill off senior citizens. Such a charge would be laughable if it weren't so cynical and irresponsible. It is a lie, plain and simple.

Ugh. He says nothing more about the genuine concern that there will need to be rationing, that lines will be drawn, and that he himself has said things that suggest that someone will be deciding when older and disabled persons will get "the blue pill" instead of vigorous treatment.

There are also those who claim that our reform effort will insure illegal immigrants. This, too, is false – the reforms I'm proposing would not apply to those who are here illegally.

An important promise.

And one more misunderstanding I want to clear up – under our plan, no federal dollars will be used to fund abortions, and federal conscience laws will remain in place.

But insurers will have cover abortions, and people will have to do business with insurers.

My health care proposal has also been attacked by some who oppose reform as a "government takeover" of the entire health care system.... Now, I have no interest in putting insurance companies out of business... But an additional step we can take to keep insurance companies honest is by making a not-for-profit public option available in the insurance exchange.

Why is something more needed to keep them "honest"? You're imposing new regulations on them. Enforce those regulations. Why is more competition needed to make them "honest"? I'm saying "more competition," because Obama is clear that the public option will be a separate entity that must operate solely on the premiums it collects and free of any taxpayer subsidy. Won't that coverage be expensive too, then? He claims that "by avoiding some of the overhead that gets eaten up at private companies by profits, excessive administrative costs and executive salaries, it could provide a good deal for consumers." But private companies try to control costs to compete, and government entities tend to get bloated too. It's hard to see what this is for.

... I will not sign a plan that adds one dime to our deficits – either now or in the future. Period. And to prove that I'm serious, there will be a provision in this plan that requires us to come forward with more spending cuts if the savings we promised don't materialize.

How will this promise be enforced?

This is the plan I'm proposing. It's a plan that incorporates ideas from many of the people in this room tonight – Democrats and Republicans. And I will continue to seek common ground in the weeks ahead. If you come to me with a serious set of proposals, I will be there to listen. My door is always open.

Am I allowed to shout "You lie" at the TV?

Now comes the sentimental, inspirational stuff that I don't need to spend time on.

... Ted Kennedy....

Zzzzz.... Then my ears perk up:

One of the unique and wonderful things about America has always been our self-reliance, our rugged individualism, our fierce defense of freedom and our healthy skepticism of government. And figuring out the appropriate size and role of government has always been a source of rigorous and sometimes angry debate.

Words for conservatives. Obama then concedes that Teddy seemed to be the opposite off all of that to conservatives. But somehow he really wasn't. Why? I scan the text for a reason. He had conservative allies in some of his political ventures? There's a list of friends — John McCain, etc. Eh. Not enough. Obama goes on about problems Teddy saw, kids with cancer, and it seems as if the idea is just to make us forget about the questions he'd just raised.

You see, our predecessors understood that government could not, and should not, solve every problem. They understood that there are instances when the gains in security from government action are not worth the added constraints on our freedom. But they also understood that the danger of too much government is matched by the perils of too little; that without the leavening hand of wise policy, markets can crash, monopolies can stifle competition, and the vulnerable can be exploited.

That's the kind of moderation I like, so that worked on me, but I'm sure it's a disappointment to those who got really excited by those words for conservatives.

Finally, he bemoans the lack of civil conversation again. I hear echoes of the "shut up" I heard at the beginning of the speech. He says we need to act now, not be timid. We need to do "great things" and "meet history's test." We need to do it because it's "our calling." He's entitled to end his speech with a call to action.

I'd say he did pretty well with what he had, but some of us still have questions and don't appreciate being called louts and liars.

224 comments:

"I'm afraid making the insurance business unprofitable is completely acceptable to you, because you don't mind if in the end government takes over everything. It's what you would do now if you could, isn't it?"

Have you ever been really sick? My question is, how do you know if you like the plan you have if you've never been sick? If you get sick and they dilute your coverage or drop you, will you still like your plan? I don't think that will happen to you, working at a big state school and all. But what about people who pay for their insurance out of pocket, or small businesses?

I'd say he did pretty well with what he had, but some of us still have questions and [don't] appreciate being called louts and liars."

Obama starts off by trying to cut off debate and calls people who disagree with his interpretation of bills the Congress hasn't even passed yet "liars."

How is that leading? How is that an attempt at persuasion?

If I'm trying to sell you a car, I don't start off by telling you to shut up and calling you a moron. I'd never make the sale.

And Obama will never make the sale.

I have a word of warning for all Republicans: If any of you vote for this, you won't get my vote or my money in 2010.

On the other hand ... if you all vote against this, and defeat this Democrat attempt to take over a significant portion of our lives, I will do everything I possibly can to help return you to power in the Congress.

This vote will be just another vote for Democrats. For Republicans, it could mean the death of the Party.

(May I make a polite suggestion? When a post is this long, could you break it into chapters--with little section numbers and headings? Just a thought! I'm not telling you how to write your blog, but when a post is this long, and when it's something that I actually want to read, it's helpful for there to be some structure. Also makes it easier to discuss.)

Obama goes on to describe the insurance exchange that will improve the market for people who don't now have health insurance and the tax credits that will help "individuals and small businesses who still cannot afford" insurance.

I'm pretty sure the tax credits are really outright subsidies -- individuals who aren't able to afford health care are unlikely to be paying enough in tax that some tax credits will give them enough extra cash to buy the government mandated insurance packages.

This is also one of the reasons why the abortion issue has loomed so large -- if there are subsidies out of taxpayer money, many taxpayers are concerned that those subsidies could be funding abortions, even if abortion isn't directly included in the mandatory insurance specification.

Well the time for bickering is over. The time for games has passed. Now is the season for action.

What I hear is: Shut up.

Because that's exactly what he's saying. What he's been saying. He's said it in plain language. That is his response to disagreement. Shut up. I won. You made the problem, now shut up and let me fix it.

The "no cap" thing really shocked me, though I was reminded today my HMO has no cap already (but of course, my PCP has to sign off on anything I want, so they limit things other ways.)

But I think its stupid to say all health insurance has to have no lifetime cap. If I had a $5 million cap, I'd be fine with that. You tell me it costs more than $5m to keep me going, I'm happy to say, hey, lets let me go.

This is completely off-topic, and not meant to be a threadjack, but I am thrilled -- THRILLED -- that Ellen Degeneres is the new 4th Judge on Americal Idol. I hope the news reports are true. It's too bad that Kara Diowhat'sherface is still there -- she should be out and Paula in -- but I think I'll like EG's POV.

The other problem with this pledge, which he repeated for effect, is that it tethers Obama to the deficit-estimating methods of the CBO, which in turn leads him to endorse a plan for mandatory "spending cuts if the savings we've promised don't materialize." That won't reassure voters worried about, you know, spending cuts, and it doesn't make any policy sense.... Keep in mind, these are cuts that go into effect after the administration's plans to pick the low-hanging fruit of "waste" that doesn't impact care have been exhausted. Doesn't that imply that the mandatory spending cuts will come at the expense of care?

The point about death panels/ lies that you are missing. OK, it is grandstanding and theater all around. Various people— including standard bearers like Sarah Palin— were claiming that the health care bills being proposed would set up panels of experts to judge whether patients should receive care after a certain point in life, due to costs. OK, then give that a sinister name, “death panels.”

First of all, the bills simply DON’T do that. So then we hear that, no, we’re not supposed to take the claims that death panels will be created literally. You see, it’s a METAPHOR about what reform of the health care system would lead to somewhere down the road.

OK, but you can’t flat out say, “Obama wants to create death panels,” and then when challenged go, “it’s a metaphor.” That is not acceptable because you’ve already created a stir among people on the sidelines who take you literally.

So then, if Obama goes up and says, “the literal charge that I’m creating death panels is a lie,” you can’t feel attacked. Because that part is true. The literal claim IS a lie,

I think what you’re saying is that you are hurt because Obama isn’t going the extra step and addressing the concerns brought up by the death panel metaphor. Which I don’t think is fair; in an argument like this for those people on the sidelines, you have to fight fire with fire. If he conceded the validity of the premise he would be conceding defeat.

Maybe you want to find a standard bearer or spokesman who can voice your actual concerns directly, and not in the terms of an inflammatory metaphor, that of course will require the proponents of the plan to call you out for being liars, which you are if you mean “death panels” literally.

"by avoiding some of the overhead that gets eaten up at private companies by profits, excessive administrative costs and executive salaries, it could provide a good deal for consumers."

1) The fourth-largest health insurer in the U.S. is a nonprofit, so let's cut item #1 off that list. (Given that said insurer is headquartered in Chicago and is the provider behind Blue Cross Blue Shield of Illinois, you'd think Obama would already know this.)

2) Yeah, Medicare has lower administration costs than private insurance. That's because the administrative costs of collecting money shows up on the books of the IRS and (in cases where Medicare charges premiums) the Social Security Administration. Hiding administrative costs on somebody else's balance sheet is not the same as having lower administrative costs.

3) Average federal salaries exceed average private sector nonprofit salaries. Cutting a bit off the top salaries doesn't save money when all the lower-level employees are overpaid.

Does Phosphorious always have this much trouble with conditional sentences? In light of Obama's past statements of support for single payer, you almost have to conclude that he'd have government take over health insurance if he could.

Jefferson would have put separation of food/medicine and state in the constitution right next to separation of church and state if he had thought it would come to this. From Notes on Virginia, the Religion chapter, writing about why an established church is a bad thing: "Was the government to prescribe to us our medicine and diet, our bodies would be in such keeping as our souls are now."

I just posted this on the previous thread, but I think it fits better here, as it resonates with Obama's concession to the Founders, "our predecessors understood that government could not, and should not, solve every problem. They understood that there are instances when the gains in security from government action are not worth the added constraints on our freedom."

2) Yeah, Medicare has lower administration costs than private insurance. That's because the administrative costs of collecting money shows up on the books of the IRS and (in cases where Medicare charges premiums) the Social Security Administration. Hiding administrative costs on somebody else's balance sheet is not the same as having lower administrative costs.

A lot of the costs of policing Medicare fraud are also displaced onto the HHS Inspector General, the FBI, the DOJ, and the courts system.

Seriously? I’m so glad I quit that show. Ellen judged on SYTYCD and it was lame. She spend half the episode making jokes, which I guess that’s why they invited her, but it was not good. Maybe she’d be better on a singing show, where you don’t have to know what a brise (?) is, but I wasn’t impressed.

The new system — requiring insurance companies to cover pre-existing conditions and not to charge different rates even for those who begin with very expensive medical needs — won't work unless all the healthy people are forced to join and pay in much more than they are taking out.

As someone who pays for my own insurance, despite not having an actual medical claim in years, that's exactly what I heard, too. Apparently, being young and healthy is gaming the system.

What struck me from the speech was the juxtaposition of this healthcare reform with past efforts.

In 1933, when over half of our seniors could not support themselves and millions had seen their savings wiped away, there were those who argued that Social Security would lead to socialism. But the men and women of Congress stood fast, and we are all the better for it.

...now, if you'll excuse me, I'd like to add health insurance to the government portfolio of banks and industry. Just don't call it socialism; the time for that debate has passed. And don't ask what it costs, I promise you we'll deliver more services to everybody and it will cost you less (unless you weren't paying for insurance already...you greedy capitalists).

WV: avirisl -- The state of the American Public with respect to ObamaCare

Free Markets! They will have to find ways to become profitable with the companies that are.

GM, usually you're funny in your pithiness even when I disagree. You know, like, always. But this particular comment isn't funny, but sad - it's clear that you know the definition of neither "free" nor "markets."

You voted for him! is fast becoming the new You, a law professor! Use it sparingly, fellas.

And in fairness, it's not like someone who actually believed the blather he spouted on the campaign trail would have been led to expect he would endorse a plan like this. Back during the Democratic primary, his health care "plan" was just a knock-off of Clinton's, with one crucial difference -- his didn't have a mandate, enabling him to demagogue the issue shamelessly, in his usual fashion (the mandate apparently didn't poll well at the time, even among Democrats). One would have been justified in expecting that Obama would reject such a mandate today. Of course, one would have been wrong, but that doesn't make the error unreasonable.

If Obama's stated policy preferences during the campaign had actually been in any way reflective of deep or serious thought, on his part, about the appropriate approach to health care reform, this bill would look very different. But the man isn't a policy wonk. He's not a thinker. He's a talker.

Ow, ow, ow, now i have neck pains from nodding so much reading the post, Ann.

The only thing i would add is that the real undercurrent of the speech is he seems genuinely irked that he has the presidency, and filibuster-proof majorities in congress, but its still hard to get this done. it feeds back into his comment ages back that "I won." He thought this would be much, much easier. He seems to want to shout, "how much more power does my party have to have before it gets this done?"

Phos:

> Heavy regulation is not nationalization.

Offering a public plan and then regulating the private industry out of existance IS nationalization. Which is Ann's point.

Luckily, Obama isn't willing to make even the slightest gesture across the aisle. I say luckily because he could easily snare enough RINO votes to pass a health care bill with three quarters of what he wants were he to include meaningful strictures against taxpayer funded health care for illegals or a provision allowing health insurance to be sold across state lines. But he won't. Which means there's a chance we'll escape the nightmare he has in mind for us.

And in fairness, it's not like someone who actually believed the blather he spouted on the campaign trail would have been led to expect he would endorse a plan like this.

I'm trying to remember a time when you should ever believe what a politician says when it is in contradiction to what he has done. He lived a life of promoting marxism. Why did anyone expect anything else of him, let alone believe his very weak blather?

Ann, Although you often see the President's shortcomings now, you are still easily conned by him. It seems he can just say the right words and you think: Oh yea, there's the guy I thought you were. Nearly every part of the speech was dishonest. Read the Powerline.com analysis. He's still delivering really bold faced crap.

When do you finally just accept that people who lie a lot, lie especially about the important things. They don't stumble into lies at this level. They sit around with a team of advisers and plan the lies so that you will swallow them. Surprisingly they are very poorly disguised. Sometimes not at all, just thrown right out there due to arrogance.

"In 1933, when over half of our seniors could not support themselves and millions had seen their savings wiped away"

This is a lie.In the Depression, the worst-off were children; the elderly actually fared pretty well. And the first Social Security check wasn't even issued until January 31, 1940, far too late to help old people in the throes of the Depression.

In fact, internal Social Security board statistics at the time clearly showed that children were more impoverished than the aged during the 1930s, and the extent of dependency among the elderly was exaggerated to protect the 1935 Social Security Act.

By 1941, just 23% received Old Age Assistance (which did not require proof of need), a figure far below the two-thirds poverty rate for the aged claimed by reformers.***

"...there were those who argued that Social Security would lead to socialism."

Turns out they were precisely correct, but a half-century off.

***Brian Gratton, The Poverty of Impoverishment Theory: The Economic Well-Being of the Elderly, 1890-1950; The Journal of Economic History; Mar. 1996, pp.39-61.

Make no mistake: However the government structures Health Care, someone in the US will figure out a way to make a fortune off of it.

Yes, under the plan, the government will fine people if they fail to buy health insurance, and will subsidise the purchase of health insurance if they're too poor to buy it. And the government will mandate a uniform qualified health benefits plan for all the insurers to offer.

How ever will the health insurance companies make money off of the hundreds of billions of dollars the government is directing their way, especially after the government has worked so hard to reduce product differentiation!

Thanks for writing this. You clarified some of my concerns. One is that if he marshalls in a plan by the government, it's going to affect the whole health care field and drive many companies out of business, thus creating a monopoly even if that's not what he's saying he's going to do.

The guy is dishonest about his intentions. It's like the elephant's nose in the tent.

You know that the elephant wants in the tent, but he's saying, now now, moron, just a nose! That's it! I just want to warm up my nose! And then suddenly he's upacking his track, and you have to move out if you want a night's sleep. And of course we know how that works out.

The Barack Obama health insurance plan does not exist. It is a fiction, fleetingly described in an angry speech by a petulant president intent on imposing his will on a justifiably skeptical citizenry.

"Oh, it exists!" you proclaim.

No, it does not, else you and I could download, print and read it.

What does exist is HR3200, which has passed through two committees in the House of Representatives and will soon be introduced to the floor for debate and vote, or shuffled into the reconciliation process to bypass the career-killing vote process.

President Obama's speech did not in any substantive way correctly describe HR3200. It did, in fact, substantially differ from the content of HR3200.

"I get it. Nothing will require anything of me if I have what I like (and I do). But if you change the structure of the insurance market, my company may not survive or it may be forced to change. Then how do I keep what I have? What I have now may not exist in the future. This is why I do not feel secure."

In other words you oppose change of any sort, because it makes you feel insecure. What are you hoping to debate?

Von Mises:"Ownership is power of disposal, and when this power of disposal is divorced from its traditional name and handed over to a legal institution which bears a new name, the old terminology is essentially unimportant in the matter. Not the word but the thing must be considered.

Limitation of the rights of owners as well as formal transference is a means of socialization. If the State takes the power of disposal from the owner piecemeal, by extending its influence over production; if its power to determine what direction production shall take and what kind of production there shall be, is increased, then the owner is left at last with nothing except the empty name of ownership, and property has passed into the hands of the State.""

"Obama goes on to describe the insurance exchange that will improve the market for people who don't now have health insurance and the tax credits that will help "individuals and small businesses who still cannot afford" insurance."

"System complexities can lead to gaps in coverage. With the multitude of programs offered by Massachusetts,all with varying eligibility and programmatic rules, residents with fluctuating incomes and employmentstatuses can fall through the cracks"My experience in the business is that people are as frustrated with the complexity and bureaucracy as they are with the cost. Not that private health plans are great at simplifying things but I do have concerns that the public option and the "insurance exchange" will create more frustration due to the increased bureacratic complexity.

As I said above I would encourage you all to read this report. this is the model that Pres. Obama has used. Its had some signficant successes but also some serious problems, not the least which is the exploding costs (not addressed in this report).

I've paid for health insurance all my adult life. I've had very expensive cancer (cured) and thus am a very high risk preexisting condition person.

I need health insurance no matter what. If I lose my job I may lose my insurance and then everything if I get sick again. Regardless, I still oppose this plan simply because I think it is bad for our country and the world health care that depends on us. I'll find a way to take care of myself or not, but it is my problem. I do think we can do better than allowing someone like me who has done it right to be dumped after doing so.

I don't know what the solution to the preexisting condition problem is. Right now everybody is covered since nobody is left to die in the street. Therefore, the money is there.

In my case, it seems unfair that after paying for insurance my whole life that I cannot get it now if I lose my job or it's insurance benefits. I also understand that insurance companies cannot insure people only when they get sick.

Although it is against my basic instincts to have the government force people to buy things, it seems that if we are going to force hospitals to treat people with or without insurance, then we need to require contribution from everybody more equitably. Right now, the insured are paying for everyone else.

I think we'll see this cropping up more and more often as the Obama administration continues its meandering towards Epic Fail history. Sadly, there are very few Obama triumphs to record (the Somali pirate situation's resolution was a good one) and numerous gaffes, blunders, and missteps. All of the arguments that Obama's opponents presented -- inexperience, radical ties, Chicago machine pol -- have borne out.

I'm wondering if Ann will ever say her vote was a mistake. What will it take for her, and the millions of other Americans who voted for the idea of black President, not for the actual candidate, to wake up and realize that was foolish? Will they ever come to that point? If they do, will they ever admit it in public?

McCain certainly would not have been perfect -- the internal disagreements in that administration would have made great reality tv -- but he would have avoided Obama's rookie mistakes, naive foreign policies, and blatant power grabs. Has anyone seen "Don't blame me, I voted for McCain" bumperstickers? I'm already seeing "1/20/2013" here and there.

They are there in the mildest of forms because you can sue the insurance companies. Once the government is deciding best practices uniformly, the patient will be helpless against the panel that decides how much you get before you die (Death Panel)

In my case, it seems unfair that after paying for insurance my whole life that I cannot get it now if I lose my job or it's insurance benefits.

That's an argument for expanded portability protection. The current kludge (HIPAA) seems to get around this with a limited pre-existing condition exclusion, although the easier solution is to allow people to continue with their current employer-funded health care plan, if they will take on the burden of paying the premium directly, rather than having their ex-employer pay. That might be difficult, given that not every employer health plan is "off the shelf," as it were, but it seems more sensible than trying to work around the problem with a raft of regulations about what pre-existing conditions can and cannot be excluded based on when they arose and were diagnosed, etc. etc.

More broadly, a shift in the market away from employers picking and choosing actual health plans and towards a system where employers simply provide a health insurance allowance, which employees can use for the purchase of the health care plan of their choice (and which they can top off with their own funds if they want a more expensive plan), would be healthy for the market. It would certainly disrupt the existing pattern of health care coverage, but I'm not opposed to change, just the kind of change the House plan represents.

My barometer for Obama's speech was " Will he call for a program that would subsidize medical training with a goal to increase the number of doctors and nurses?"

Obama did not do that which told me he does not care if this plan works. He does not appreciate nor respect the energy and effort doctors have invested in their profession and Obama has absolutely no vision for the country except socialism!

As soon as I sign this bill, it will be against the law for insurance companies to drop your coverage when you get sick or water it down when you need it most.

And that will change the economics of insurance.

Well, if the “economics of insurance” are based on watering down coverage when it is most needed, then what the hell kind of an industry is that? They generate revenue by issuing illusory contracts that they then breach at will? (actually for employment-based coverage they do). You know, as I understand it an essential underpinning of a free market system is the rule of law, which includes consequences for breaching contracts.

Florida said:

If I'm trying to sell you a car, I don't start off by telling you to shut up and calling you a moron. I'd never make the sale.

There is a basic problem with health care as with many institutions in a free market. Many people, when given the choice, will choose foolishly and end up needing others to save them. This is really the root cause of our current recession and many budget issues.

We will not be willing to let people suffer the consequences of their poor decisions on health care by letting them die from it. We just won't, and shouldn't. Therefore, we need to force them to do the right thing and pay their way. This is a Pandora's box, but I don't see a way around it that is both fair to all and compassionate to the stupid.

We will need to mandate insurance, as well as competitiveness. A stupid person can opt for less convenient insurance,i.e., longer waits, poorer service, life saving drugs only, fewer diagnostics, etc., but they must have catastrophic coverage and coverage of anything that the hospital is required to provide.

The silliest line I heard was (paraphrasing) "I'm going to be the last President to deal with health care!"

So the first pass at restructuring 1/6 of our economy, many of the provisions of which do not take effect for four years, will be perfect? Is that what he's saying? Even if this the right path to go down, it will take continuous tweaking and refinement for the rest of the program to get right. We face this sutuation with Social Security, Medicare, the Post Office, national defense, etc.

Has he never heard of entropy? It's like saying you've weeded the garden for the last time or done your last load of laundry.

If this bill passes, he enusres the intimate involvement of every future PResident in health care.

I guess we got the President we deserved. And we're going to get this health care mess, despite the valiant fight by the grass roots opposition. It won't be reform, it will be (eventually) socialized medicine.

"William said... The profit motive seems to attract the best efforts of the hardest working people. Why should the profit motive be considered so wrong when applied to health care?"

Why, nothing is wrong with pure profit motive for pure Freedoma Lovers!! within the healthcare, employer provider, and insurance industries as long as you accept the downside is purely free market driven and has nothing to do with morality --because going with pure profit motive means the abovesaid would accept certain people, but not others.

Pure profit and wonderful unfettered capitalism would mean hospitals could turn away illegals, wefare mommas, Medicare recipients, trauma cases where the insurance coverage looks shaky. And drug companies could charge whatever the market would bear , especially juicy for a company that has an effective monopoly on a life-saving or life enhancing drug with no "competitor".

Doctors would be free to turn down malpractice risks that threaten bottom line profits, like at risk pregnancies, shed their own share of Medicare and state welfare cases they lose money on. And perhaps freer to prescribe any drug that nets them the best kickback and repeat charge - like a weekly charge for renewing oxycontin.

Insurance companies could use the genetic screening they have dreamed of using, drop anyone they fear is now unprofitable or an unacceptable risk. Same with nursing homes..

NO, if you just want to structure US healthcare so professionals and owners in the field can make beaucoup dollars, oodles of them - that is relatively easy.

I don't know what the solution to the preexisting condition problem is. Right now everybody is covered since nobody is left to die in the street.

I think that is the only significant problem we have and I’m not sure what the best answer is. I don’t think it’s “force insurers to take on all those with pre-existing conditions at the same cost as a healthy 23 year old”, because if that were the case no one would buy insurance until they were sick. And then, to fix that, you have to force everyone to buy insurance. Which is a lot of tinkering to help a small portion of the population (I would like some numbers on how small-must be far less than 30 million).

If the government were just making some effort to solve this problem, I might be for it, but all this emphasis on people not even having to pay co-pays for all sorts of procedures goes way beyond that.

Also, I know bankruptcy is always listed as a fault of our system, but to me it is a strength because you can still get care, even though you may not be able to afford it. And there are lots of charitable organizations and churches who help people out with medical bills.

"In its own analysis of preventive care, CBO said earlier this month that the cost of making cancer screening, cholesterol management and other services broadly available is likely to far outweigh any savings ultimately generated."

Second, the New England Journal of Medicine:

"Our findings suggest that the broad generalizations made by many presidential candidates can be misleading. These statements convey the message that substantial resources can be saved through prevention. Although some preventive measures do save money, the vast majority reviewed in the health economics literature do not."

Frankly, you cannot trust anything Obama says. He talks as if he were still a candidate, as if fact-free arguments by assertion were still okay.

"Reducing the waste and inefficiency in Medicare and Medicaid will pay for most of this plan." --the President, last night (emphasis added).

What I can't figure out is why if there is so much waste and inefficiency in Medicare and Medicaid, that isn't wrung out first. It shouldn't take a 1,000+ bill to do that. Rather, just start enforcing the laws and regulations that are already on the books.

Indeed, in my reading of the major House bill, I didn't see anything that directly translates into better enforcement in these programs.

Also, another of the reasons for their lower overhead is their lack of enforcement. The minimization of fraud and abuse costs money, money that is not being spent right now on those programs.

So, I come back to my previous point - if there is so much money to be saved there, then just do it. And if Obama is successful there, he would have a track record, so that we could trust that he was actually capable of bettering the system. All we have so far are high sounding words.

I think that is the only significant problem we have and I’m not sure what the best answer is.

I guess when it comes down to it, I think it might be better to just help people who have major a medical crisis on a case by case basis as a society, or even as the government (whether through bankruptcy or some other mechinism) then to try to change the whole system, and spend billions of dollars, all in support of some elusive fix. We’d probably get off cheaper.

We will not be willing to let people suffer the consequences of their poor decisions on health care by letting them die from it. We just won't, and shouldn't. Therefore, we need to force them to do the right thing and pay their way. This is a Pandora's box, but I don't see a way around it that is both fair to all and compassionate to the stupid.

Fair would be to let them suffer for their mistakes. You are essentially telling us that we should be willing to accept lower quality health care, all the way around, in order that those who would rather spend their insurance money on beer, can get health care equivalent to ours when they need it.

Doctors would be free to turn down malpractice risks that threaten bottom line profits, like at risk pregnancies, shed their own share of Medicare and state welfare cases they lose money on.

I'm pretty sure doctors already do this -- anecdotally, at least, I've heard of doctors getting entirely out of handling pregnancies precisely because of malpractice risks. And -- while it's not connected to malpractice concerns -- doctors in my own family have essentially given up on trying to service Medicaid patients, because the bureaucrats administering the programs are so totally incompetent.

And if 18 months isn't a long enough time for Cobra, we could just extend the length of time, problem solved. Or heck, we could extend it indefinately. The insurance company should be ok with retaining you if you've paying full premiums, and it would solve some portability issues.

I think we have way too many laws and regulations but insurance companies should be required to keep an ex-employee in their insurance as long as they pay their premium bill. Where is the downside in that? Why did Congress limit it to 18 months??

You can probably tell I favor de-coupling health insurance from one's job.

"You are essentially telling us that we should be willing to accept lower quality health care, all the way around, in order that those who would rather spend their insurance money on beer, can get health care equivalent to ours when they need it."

Yes, exaclty. . . and be able to ride in a limo to the doctor's office.

"Fair would be to let them suffer for their mistakes. You are essentially telling us that we should be willing to accept lower quality health care, all the way around, in order that those who would rather spend their insurance money on beer, can get health care equivalent to ours when they need it."

There is no reason it has to be lower quality, as I said we already cover (treat) them now. But if fair is letting them die untreated, then that just ain't gonna happen and is not realistic. That leaves the only remaining thing, short of socialist care, is forced contribution combined with forced competition and not from a phony "public option" that would force all companies to offer identical plans.

"There may be those—particularly the young and healthy—who still want to take the risk and go without coverage," he warned, in a passage defending compulsory insurance. "The problem is, such irresponsible behavior costs all the rest of us money. If there are affordable options and people still don't sign up for health insurance, it means we pay for those people's expensive emergency room visits."

Oh dear lord, I just read this part at Reason that I had missed earlier. What this means, Mr. President, is that you want 20 - something healthy young people are being selfish by not paying for care they DON’T NEED. BS!

Shanna:I just read your 2nd comment. I guess great minds do think alike!

Heh, Indeed. I don’t see the harm in letting people continue to pay the premiums for insurance they had under their employer, if they are no longer working there. It would solve a chunk of problems right there.

Last year the Spousal Unit and I had our 5 year wellness checkups and our insurance covered everything, including two colonoscopies and a bone density scan for me.

We paid $100.00 co-pays for each colonospcopy and a $20.00 co-pay for each diagnostic procedure, the whole ball of wax cost us less than $500 and BCBS paid out about $12k.

BCBS/Anthem calls to remind me when my annual tests are due, so WFT is Obama talking about when claims these procedures aren't covered by insurance or that insurance companies don't encourage wellness?

I like the way our Occidental/Columbia/Harvard educated Law-Professor-In-Chief takes the tort-reform bull by the horns and ... and ... oh, never mind, jump it, I suppose.

I look forward to the day I can turn the sound back on my television.

We do extremes. We swing from a president overly impressed with American exceptionalism but who cannot effectively communicate to another who is attracted to globalism but cannot control his furor loquendi.

Speaking of furor, I sure hope we get some good protests around here. I'm next to the state capitol and I got a cool new lens that can take it all in.

It will cost less? I just don't believe that prevention and early detection will perform the necessary magic. And who will provide all this extra care?

Proof: Sally Fields is shilling Boniva osteoporosis medication. She disclaims why she's taking it by saying that she always tried to eat right, exercise, take calcium and all the other preventatives and she still got osteoporosis and now needs monthly dosage Boniva.

"There are also those who claim that our reform effort will insure illegal immigrants. This, too, is false – the reforms I'm proposing would not apply to those who are here illegally."

An important promise.

And one that is a lie and one that could have been iron clad in legislation, but was defeated in committee when added as an amendment. It is a promise that cannot be kept because illegals already burden the system as it is. Go to an emergency room and take a look at how they tap into our healthcare system. If universal health care passes in America, illegals will flock here like never before to get the free medical care they don't get now and when the sympathetic cry goes out that they are being denied this basic human right, well, then either amnesty will follow soon after or the promise of shutting out illegals will be ignored. It's a lie and Obama and his cadre are liars.

Shanna and AJ, Yea, I agree. The patient is the same entity and risk whether he has that job or not. Why this major obstacle exists, I don't understand.

Decouple and allow interstate competition and I can afford my own insurance as could most people since it would cost about the same as cable TV combined with cell phone service. I would give those up first. Or find a way to make the extra money.

Shut up and obey are no where to be found last night except of course in the responses on Faux Noise afterward.

but the point is well taken. if you are a liar like many of the republican right wing seems to be, the by all means shut up. if you don't get into working toward a solution then you are just in the way and you should be told to shit or get off the pot.

that jerky rightwing circus does nothing to help the situation. they offer nothing. and those who like that asshole Wilson for shouting liar at the President...I'm curious why mr.doright kept his yapper shut every time GWB told yet another whopper.

Frankly i wish that some of you all would find a new home. you are so tiring and so sillysounding.

Where will all these people get the money to buy insurance? We're told that some people and businesses will get "a hardship waiver," but we aren't told where the cut-off point is.

And this is really a big problem that is being ignored. Forcing companies to provide coverage for everyone will drive up their costs, and thus, as a result, force out employees of marginal (i.e. borderline) utility. Making this worse are the recent and pending minimum wage increases. And the part of the economy who are most vulnerable to both of these problems are those just entering the work force. And, a lot of them are the approximately 1/3 or so of the uninsured who are late teens and twenty something males for whom health insurance is a bad buy (and will get much, much worse, due to the requirement that the companies do at most a 2/1 age rating).

So, the government is hitting this demographic extraordinarily hard. They are being forced out of jobs due to the minimum wage increases, and if ObamaCare passes, having to buy very expensive insurance, that they mostly don't need.

Of course, I probably shouldn't feel too sorry for them, because they are also the demographic that fell hardest for the Hope and Change stuff.

"What this means, Mr. President, is that you want 20 - something healthy young people are being selfish by not paying for care they DON’T NEED. BS!"

Well yes, exactly. That's the nature of insurance and why it works: You pay when you don't need it and they pay when you do. Or do you think, you should be able to buy car insurance to pay for accidents you already had?

Decouple and allow interstate competition and I can afford my own insurance as could most people since it would cost about the same as cable TV combined with cell phone service. I would give those up first. Or find a way to make the extra money.

If "allowing" interstate competition were all that was being proposed, then fine. Let insurance companies sell into other states.

But there are a number of reasons why insurance costs more in some states than in others. One is the cost of living. Another is the malpractice environment. And, another are state required mandates.

I frankly don't see why it is to most of our benefit to subsidize those who live in high cost areas of the country (probably not coincidentally, mostly "Blue" states) by paying more so that they can pay less. And, if those people allow their legislatures to enrich the malpractice attorneys and require treatments that most would not elect to pay coverage for, then why should the rest of us subsidize them?

Well, sure, but with health insurance as it stands, you actually get to decide if it’s beneficial to YOU to buy that insurance. Obama wants you to do it because some grandpa, who probably has a bunch of money in the bank that you certainly don’t have, and has had a lifetime to work his way up the career ladder so is probably making more money than you, wants a cheaper policy. He wants you to feel guilt tripped into this, or he wants to force you into this. I don’t like that the President is out their whining that these people are selfish. Maybe the older folks are selfish for wanting cheaper premiums, since they are the one’s actually using medical care.

Or do you think, you should be able to buy car insurance to pay for accidents you already had?

But, you’re required to buy car insurance in case you run into someone else, right? You don’t have to buy insurance for your own car. If you want to take your chances, that’s ok.

If interstate competition were allowed you could buy the best deal available nationwide. This would lower rates for everyone. If you happen to live in a place with the lowest rates, then even those would go lower because they have a semi-monopoly and thus are charging more than they need to even at those low rates. Another company will come in lower anywhere there is gouging going on. I've run a national business my whole adult life and this is what happens. Competitors jump all over you if you are charging too much for what they also can sell there. There would be enormous saving from this. Just imagine the pricing if you could only buy a couple brands of TVs in your state. They would drain you.

Lib: I think we should do X.Con: I disagree.Lib: OMG! Stop being such a rabble rousing, racist domestic terrorist! When can we have a nice civil discussion where everyone agrees about everything, like in College or in the MSM!

I'm old enough to remember when Ronald Reagan was going to wring waste, fraud & abuse out of welfare, and every speech on the subject was accompanied by an infuriating anecdote about a "welfare queen" who was ripping off the rest of us honest taxpayers.

That sort of rhetoric works well in the righteous indignation department. But the only sure way to make government less inefficient is to make it smaller, which is what Clinton-era welfare reform did, in no small part by instituting "death panels" that decided who deserved benefits and who got the boot.

But I believe I have a solution. Japan has the world's longest life expectancy (excepting Macau and Andorra), yet spends half (percent of GDP) what the U.S. does on health care. Oh, and Japan does very few organ transplants, though for $300,000, a Japanese citizen can line up for a new heart in the U.S.

So providing organ transplants doesn't seem to correlate well with overall life expectancy, but it does bring in a boatload of cash. There's your financing mechanism.

@Shanna, COBRA is not standalone insurance, it's continuation insurance. You must maintain the same group coverage on COBRA that you had when employed. The only benefits you can drop are none core services such as vision or dental. You must also pay 100% of the premium which can be a real shocker if you've had all or a percentage of the premium paid as part of your employment agreement.

Also, what happens to employees happens to those with COBRA such as benefit, premium, deductible or co-pay changes. If the employer goes out of business or drops medical coverage to employees then COBRA coverage/eligiblity ceases and you have 63 days to obtain new coverage without pre-existing condition restrictions.

If interstate competition were allowed you could buy the best deal available nationwide.

There actually is no legal prohibition to selling insurance across state lines now. You just need to get approved by the insurance commissioner (typically) in the state in which you'd like to do business. The impediment is that as of now to do that you need to satisfy that state's various rules about mandated benefits and such.

The proposed changes involve removing that requirement, so you only need to comply with the rules of the state in which you are based, and can then sell in any other state ( or any other state in the inter-state compact contemplated by the Baucus bill).

The problem with that is the race to the bottom which would inevitably occur. Insurance companies would immediately relocate to the state with the most lax requirements and from there sell policies all over the country. The comparison that comes to mind is the credit card industry, how they all happen to be based in either South Dakota or Delaware, and how they mistreat their customers.

"But, you’re required to buy car insurance in case you run into someone else, right? You don’t have to buy insurance for your own car. If you want to take your chances, that’s ok."

The difference is that hospitals have to treat you whether you bought insurance or not. This forces them to take it from "grandpa" in premiums to pay for the kid who thought he wouldn't need it. It would be the same as car insurance if the insurance company did have to fix your car even if you had no coverage.

There is no fair way to have private insurance AND mandatory hospital treatment without making everyone pay. Otherwise, you are just making the "grandpa's" (rich or poor) pay all the bills.

The problem with that is the race to the bottom which would inevitably occur. Insurance companies would immediately relocate to the state with the most lax requirements and from there sell policies all over the country.

Wait, is this a bug or a feature? I can see federalism concerns about undermining states' attempts to interfere with their residents' freedom of contract, but from a policy standpoint, that actually sounds pretty good.

"By my reckoning, no room of this sort has EVER talked back to a presidential guest before.

I have a rotten cold/sore throat/stuffed head (not H1N1 aka swine flu) and am not feeling well today, so I must be reading you wrong."

C'mon people, you're better than this! You don't have the story down yet?

I would have thought that you would have had MILLIONS of examples of democratic congresspersons persoanlly insulting the president during an address to a joint session of congress now. You have some youtubes of booing, some footage of democratic citzens insulting Bush, some cases of democratic politicians insulting Bush outside of a formal address. . . but nothing equivalent in boorishness to what Joe did.

So the story HAS to be that Joe was UNIQUELY BRAVE, right? No other congressman in HISTORY ever stood up to a sitting president in this way. . . GO JOE!!

Which is it? Joe Wilson; Folk Hero?

Or Democrats do it too. . . BUT WORSE.

You have to settle on one plausible narrative. I thought you knew that.

@Shanna, COBRA is not standalone insurance, it's continuation insurance. You must maintain the same group coverage on COBRA that you had when employed. The only benefits you can drop are none core services such as vision or dental. You must also pay 100% of the premium which can be a real shocker if you've had all or a percentage of the premium paid as part of your employment agreement.

Believe me, I'm well aware of all of that. I'm just saying it's a good option for people who need to maintain coverage during job changes/unemployment etc... It wouldn't solve cost issues, but portability ones.

Wait, is this a bug or a feature? I can see federalism concerns about undermining states' attempts to interfere with their residents' freedom of contract, but from a policy standpoint, that actually sounds pretty good.

Well, I think it's a bug absent some minimum level of consumer protection, which I am concerned that most-lax state would not provide. You could federalize it I suppose to create a floor below which state regulations could not sink. I will go into broken record mode here and refer again to my ERISA-reform blog for an illustration of what happens to people if regulation becomes too lax. We already have that situation for employment-based coverage. The across-state-lines proposal would in effect spread that problem to all insurance.

Rich, I'm down with all that, and I think it should be done with a few minor regulations, but this:

"The comparison that comes to mind is the credit card industry, how they all happen to be based in either South Dakota or Delaware, and how they mistreat their customers."

I don't see. There is nothing about being in Delaware that forces a company to treat it's customers unfairly. They do because we as customers let them, by buying their product and then misusing it. I have never paid a dime to a credit card company in fees or interest and I've had a card my whole life. All that's really needed there is regulation requiring simple and clear "small print" in larger font. If people still choose to break that contract then they get dinged. I never have.

When her formula finally worked, the first words she heard were "see Alice .the boner". .

My neighbor asked me if I've ever tried Viagra, and I said no. He goes "DUDE", went inside and came back out and hands me one. He asked me a few weeks later if I "did cut it in half, right"??? I'm like that would explain that. Pretty impressive little pill I must say. LOL

To repeat the Thatcher quote, "The trouble with Socialism is that one day you run out of other Peoples money ". In the dawning of Baby Boomer FICA entitlements and medicare rolls expanding we have in fact reached that one day. Obama offers us his fascist alternative if we are willing to take the bait. The only other solution requires a Sarah Palin method of Drilling for our own energy again, and restoring the American workers to jobs at competitive wages with China etc.. Decisions, Decisions.

The difference is that hospitals have to treat you whether you bought insurance or not. This forces them to take it from "grandpa" in premiums to pay for the kid who thought he wouldn't need it.

On sheer numbers, “grandpa” is never coming out on the bad side of that deal. You are also leaving out the fact that when you go to the emergency room, you will get a bill. Will you pay it? Maybe, maybe not. But you are getting a bill. Some people do pay their bills, shocking as it is.

This is good, and I would go with it. If you accuse Obama of demanding special treatment, then you can laugh it off when he doesn't even get the basic politeness accorded every other president in history.

Unless some one has footage of a democratic congressperson insulting Bush during a presidential address to congress?

I don't see. There is nothing about being in Delaware that forces a company to treat it's customers unfairly.

Well, the state of Delaware (and South Dakota) law allows them to. But I wouldn't quibble about the details on the credit card side because I am not sufficiently conversant with them. I just offer it as an example of companies -- understandably -- migrating to the state where they can get away with the most.

"It's got nothing to do with health care. It has to do with eating rice, raw fish, and dried squid."

What? But I thought that spending less and living longer was proof positive of a superior health care system. We're just doing too many organ transplants. That's my post hoc ergo propter hoc correlation and I'm sticking to it.

Unless some one has footage of a democratic congressperson insulting Bush during a presidential address to congress?

The lying and demagoguery from Obama is so breathtaking compared to any President before, I salute Joe Wilson for standing up to the would-be dictator! We need more brave Americans to stand up to this creep.

Isn't it weird that the sadly inferior leftist commentariot here is hoping that a comment from the crowd at a speech is going to somehow sway public opinion and the votes of conservative Democrats in Congress?

Rich -- Delaware is the corporate capital of the country not because its laws are lenient -- they are in many ways less lenient -- but because the state's code is predictably applied.

With specific regard to credit cards Delaware and South Dakota (which has never been described to my knowledge as a "corporate capital") have the least stringent regulations, which is why credit card issuers have migrated en masse to those states. At least that is my distinct recollection from some previous reading. If I get a chance I will see if I can post a link to substantiate that, but duty calls -- I need to generate some revenue to pay for my health insurance.

In any case I believe the point remains about the likely effects of the across-state-lines proposal.

"Isn't it weird that the sadly inferior leftist commentariot here is hoping that a comment from the crowd at a speech is going to somehow sway public opinion and the votes of conservative Democrats in Congress?

Is the situation really that desperate?"

Indeed, desperately desperate. I can't remember when democrats have been in a weaker position.

I will go into broken record mode here and refer again to my ERISA-reform blog for an illustration of what happens to people if regulation becomes too lax.

From the end of the block quote in the linked entry:

ERISA has evolved into a shield of immunity that protects health insurers, utilization review providers, and other managed care entities from potential liability for the consequences of their wrongful denial of health benefits.

That doesn't sound like a case of lax regulation. On the contrary, it sounds like quite strict regulation. In favour of the insurance companies. Indeed, it sounds rather like beneficiaries would have a better time of it in court if there were no regulation at all.

That's not to say people wouldn't still sign contracts with mandatory arbitration clauses and restrictions on their ability to sue and so on. Indeed, to the extent that health insurance is provided through employers, most people actually have fairly limited choice about what health care plan they're going to enroll in, and that would make it easier, even in an otherwise-free market, for insurers to force unbalanced terms down enrollees' throats. But this is not a problem of establishing minimum standards -- minimum benefits packages or community rating, or whatever. It's a question of how the market is structured, rather than what specific products are offered on the market.

"On sheer numbers, “grandpa” is never coming out on the bad side of that deal."

We are all the "kid" and the "grandpa" eventually. These are just labels for those who currently need or don't need treatment. It still comes right back to the nature of insurance. If you don't pay when you don't need it, then you have no right to the insurance money when you finally do need it. It's just paying in installments in advance for what you may not be able to afford when you need it. If people are willing to pay out of pocket or die on the steps then it would be fair the way it is.

Simply put; the "kid" is the "grandpa". The only question is did he pay for what he now needs or not.

There is NO provision in the house bill to qualify participants. That amendment was defeated in committee by Democrats.

Amnesty is on the burner (or under the shell...). I saw an article about plans for the mainstreaming of illegals by providing paperwork changing their status to be on the "path to citizenship." (Vote buying anyone?)

Ever been to an ED at night? So who's going to provide the funds to hire security to keep illegals out?

Barack Obama is a liar.

"Reneging on his earlier promise, Barack Obama announced that he wouldn't accept public funds for his campaign...." The Atlantic

But this is not a problem of establishing minimum standards -- minimum benefits packages or community rating, or whatever. It's a question of how the market is structured, rather than what specific products are offered on the market.

I have my doubts about that. Certainly the experience of many years is that the various states all saw, to varying degrees to be sure, the necessity to rein in insurers and not to let the structure of the market take care of it. There is among other things a problem here of asymmetrical information. There is also the problem of being stuck with one insurer once one become ill. Many may states saw fit to enact bad faith legislation -- or common law principles along those lines -- precisely because the insurers left to their own devices behaved badly and ruined too may lives. With respect to employment-based coverage ERISA eradicated all those laws, and we have seen some pretty ugly results.

I'm quite concerned about menopause and it's effects. I've heard about them and I want to avoid it all. But, I've also heard that soy will make me grow manboobs. I'm conflicted. And isn't it strange that dairy-free milk would grow breasts? Is there soy-free soy?

If you don't pay when you don't need it, then you have no right to the insurance money when you finally do need it.

That would be true, except we’re actually talking about at what point someone opts into insurance. If I have no medical care needs between 20 and 30, and decide to buy insurance at 30, and then need medical care at 35, I have every “right” to the insurance, because I’ve purchased insurance and am currently under the plan when I get sick.

Yes, garage, of course health care to illegals is happening today. Under federal law, ERs must accept all comers, period. They do not turn illegals away; they can't. They treat them. They just don't get paid for it.

I have my doubts about that. Certainly the experience of many years is that the various states all saw, to varying degrees to be sure, the necessity to rein in insurers and not to let the structure of the market take care of it. There is among other things a problem here of asymmetrical information. There is also the problem of being stuck with one insurer once one become ill. Many may states saw fit to enact bad faith legislation -- or common law principles along those lines -- precisely because the insurers left to their own devices behaved badly and ruined too may lives. With respect to employment-based coverage ERISA eradicated all those laws, and we have seen some pretty ugly results.

You jump all over the place here, but I really haven't seen any real evidence that insurance companies have screwed up all that many lives.

The thing about bad faith, outrageous conduct, etc., is that they are a natural, and legal, way to rein in insurance company abuse. If the insurance company cheats you, then you can get punitive damages. That works far better than any regulator ever could.

Which is part of the problem with the proposals. The insurance companies are apparently evil in spite of all the regulation that they get at the state level, and so, the solution is apparently to nationalize the regulation. That ignores a bunch of things, including that the feds aren't really all that good at it, and that there is a much higher incentive for agency capture.

Inevitably, liberal/progressive policies fail because we don't live in a Utopia, and people are, for the most part, greedy. What is inevitably ignored is that policies that have the best intentions, and sound good in theory, almost inevitably fail because of this greed.

In particular, those who are regulated have a large financial incentive to game the system. Ultimately, they get their people onto the controlling boards and end up making policy for the industry that benefits their companies.

So, anyone who argues that the proposed legislation wouldn't result in rationing, death panels, or that illegal aliens wouldn't be covered, are looking at what the legislation requires, and not what it allows, explicitly or implicitly.

"The lying and demagoguery from Obama is so breathtaking compared to any President before, I salute Joe Wilson for standing up to the would-be dictator! We need more brave Americans to stand up to this creep."

Ok then. Now we have the story: Joe Wilson's outburst was unprecedented. . . because Obama's dishonesty is unprecedented.

But you all have to stick to this story to make it work. No "Democrats were just as rude to Bush!"

The point -- the only point -- is that it is impossible to prevent illegal aliens to take advantage of free medical care.

The issue as I see it is not that they don't have some health care coverage, but rather, that it is currently quite limited. They can go to the ER if they really really need to. But my understanding is that they are not the big abusers of ERs as primary care.

The problem is that under the current legislation, there isn't really anything in the bills we have seen that would actually prevent them from having equivalent care to that which everyone else gets, and to get it at taxpayer expense.

Yes, there is a provision that forbids it, but there is no enforcement provided. There is no requirement that people provide any sort of verifiable ID to get the same sort of health care as everyone else is getting. And, without such a requirement, there is nothing keeping unelected bureaucrats from forbidding such a requirement for a verifiable ID.

The thing about bad faith, outrageous conduct, etc., is that they are a natural, and legal, way to rein in insurance company abuse. If the insurance company cheats you, then you can get punitive damages. That works far better than any regulator ever could.

You are preaching to the choir there. The biggest problem with ERISA is that those avenues of redress are completely unavailable wrt employment-based coverage. The across-state-lines proposal, at least as understood by a lot of commentary I have read, would have the same effect: the laws of the state where you live wouldn't count, you'd be stuck with the laws of the state where the insurer chooses to locate itself, and that state (e.g. South Dakota in the case of credit cards) would afford precious little protection.

Yes, garage, of course health care to illegals is happening today. Under federal law, ERs must accept all comers, period. They do not turn illegals away; they can't. They treat them. They just don't get paid for it.

I think generally speaking, walking over dead bodies on sidewalks is unacceptable to most people in this country.

"I have every “right” to the insurance, because I’ve purchased insurance and am currently under the plan when I get sick."

Well, the legal right, yes, but moral?

If you refuse to buy insurance till 30, then get it and then get seriously ill in your early 30s, you will never pay your fair share, which means someone else has to pay for you. And what if you get seriously ill before 30. It does happen. Multiply that by millions and you have the basic root cause of the health care problem. That's it. Too many don't want to pay for their actual lifetime cost. They want a bargain at other's expense.

"you'd be stuck with the laws of the state where the insurer chooses to locate itself, and that state (e.g. South Dakota in the case of credit cards) would afford precious little protection."

Which should be handled by different policy options whereby you can buy insurance that would include the right to sue the ass off the company. Of course, nobody would choose that plan and pay for that premium.

Some basic regulation involving tort control and minimum protections for both parties so that the lawyers, who have no part in the contract, don't end up the only real beneficiaries and raising costs.

Bag -- That's insane. Insurance is a betting service. The insurance company is betting you won't get sick. You are betting that you. It's not a right. It's a simple commercial transaction. There's no moral element.

By your reasoning, children are immoral because they don't pay for their own health insurance. Old people and poor people under Medicare and Medicaid as well.

If you refuse to buy insurance till 30, then get it and then get seriously ill in your early 30s, you will never pay your fair share, which means someone else has to pay for you.

Yes. For heaven’s sake, we’re not talking about morality, we’re talking about a freaking contract! For God’s sake, should I buy health care in the womb?

This way leads to madness. Did the person who got a chronic illness at 18 pay their fair share? Maybe they shouldn't be allowed to have health insurance. What about the person who never got sick in their whole lives. Should they be entitled to a refund?

You pay your money, you take your chances. We make the decisions, and that is what people like you, and this bill, want to take away from us.

Shanna, We don't have to be enemies here. I don't want this bill or anything like it. I think the current system is great accept for a few serious holes that can ruin people and make the cost more than it has to be. We can fix them with out much government help, except to get out of the way.

Yea, the 18 year old gets a deal, but presumably his parents have paid his insurance all along so not really. It's perfectly fair. If you never get sick and die instantly, then you got ripped off I guess. I'll trade that outcome with anyone who wants to trade.

I think you and Seven are not seeing what you have at risk in the current system. Unless you have some lifelong coverage through the military or other, you could lose everything you own if you lose your insurance and can't afford it. Which happens a lot when people lose their jobs under the current system.

We are on the same side and I don't think either of you are insane, just missing my point. Which is:

If we have to treat everyone cradle to grave, then everyone should pay. No free ride? Is that really insane?

Yes, many more Democrats than Republicans were included in the poll, but isn't that the ratio of people who were watching the speech?

More to the point, Obama's problem is primarily with Democrats, not with Republicans. Republicans couldn't block it in the House if they wanted to, and Democrats could probably ram it through the Senate, even without the late Sen. Kennedy. If Obama's Saruman-powers can beguile additional Democrats into voting for the health care bill, they're home free.

If we have to treat everyone cradle to grave, then everyone should pay. No free ride? Is that really insane?

It's not insane, but it begs a question. Or at least, has a hidden assumption that I don't think everyone would agree with. If we choose to provide a service to someone, knowing he is unwilling to pay for it, does that create a moral obligation in him to pay? Lots of people would say no -- we're "officious intermeddlers," as I believe the legal phrase is, and he is not obliged to pay.

"There is nothing special about health care. It's a service, like a car wash."

Maybe this is what you are missing? It is very different. The car wash is not required to wash you car when you show up dirty. Which would then be paid for by the other paying customers, since you didn't want to pay.

It's just simply wanting something for nothing, plain and simple.

Just answer me this: Are you willing to not be treated if you can't pay? Left to die. If not, then who pays for you?

I think you and Seven are not seeing what you have at risk in the current system.

I get that, I just think that risk should be YOUR decision, not SOMEBODY ELSE's decision.

Mostly, I think what occurs in your 20's is that you are more willinging to fly through periods of unemployment, or employment without health insurance, for a period of time, without buying some sort of insurance. And in the VAST majority of cases, this works financially in your favor. I don't think the president should be out their calling you selfish for making perfectly rational financial decisions and I certainly think you have no moral obligation to purchase insurance, just to help subsidize someone else's costs. You may decide it's worth it to purchase insurance, but then again you may not. I just think it should be YOUR choice.

Which would then be paid for by the other paying customers, since you didn't want to pay.

Also, the part of this that gets ignored is that there are people who actually PAY their bills! Shocking, I know. And the other part is that the young people who roll the dice are by and large not getting sick. They are screwed if they get sick, which is why it is prudent of them to buy insurance, but most of them are making a good bet.

No one is arguing that there should not be a basic social safety net for everyone. And there is. Hospitals treat indigent patients all the time for free. The old and the poor get free or reduced health care.

Being left to die and not getting the same level of care that someone who purchased health insurance are not the same thing.

Moreover, I am all for making insurance cheaper and easier to get and keep. What I am against is a government takeover of the health care system, which is what this non-bill is about.

I hate this "no one should go broke if they get sick" crap. If someone needs a liver transplant but can't afford it unless without selling their house and cash in their 401K and move to an apartment and work more years - that's not a tragedy in the remotest sense. That's a dude living in an apartment (like a lot of unsick people) and living paycheck to paycheck (like a lot of unsick people). That's a dude who got the benefit of thousands of people's time, energy, expertise, equipment, and organs, enabling him to have a chance at a longer better life. That's a SUCCESS story.

But if that same guy isn't willing to sell his house and cash in his retirement to pay for that amazing benefit, why should I care?

"If we choose to provide a service to someone, knowing he is unwilling to pay for it, does that create a moral obligation in him to pay?"

Balfegor, The only other options are: we not choose to treat him (impossible) or we make someone else pay.

I believe that in this case he is obligated and has been all along. Just as with many other benefits of living in a society, you have obligations to one another to prevent the breakdown of the society. You have CHOSEN to be a part of it. You do so to take advantage of it's benefits and are therefore obligated to some degree.

If you want to go live as a hermit in the woods and die there, then fine. Then you have no obligation except to your environment. Even the woods will make demands on you and you must meet them or perish.

Make no mistake: However the government structures Health Care, someone in the US will figure out a way to make a fortune off of it. That's the beauty of the system we live in.

The Soviet Union had a thriving black market in which plenty of people figured out how to make a fortune off of the government-structured institutions. Many (most) of them were corrupt government officials.

However, I suspect few people would ascribe that black market to the "beauty" of the Soviet system of government.

If someone needs a liver transplant but can't afford it unless without selling their house and cash in their 401K and move to an apartment and work more years - that's not a tragedy in the remotest sense.

Actually, I believe your house and 401k are protected in bankruptcy, so it’s not even as bad as all that. Basically, you ruin your credit for a bit.

Bingo! We have to do healthcare "reform" right this very minute but it doesn't take effect until two months after the 2012 elections? Now why would that be the case if it was such a good deal for the American consumer?

"Hospitals treat indigent patients all the time for free. The old and the poor get free or reduced health care."

If you think it's free, then you and Obama have a lot in common.

I pay for that person's care through my elevated premiums. People who don't buy insurance don't pay for themselves or any of these people either.

If you feel no moral obligation, then you don't. That's a convenience, I just can't share. That's the thing about morality: you get to choose your version, I guess.

I've had very expensive treatment, that I can never repay. I have no moral problem though because I've had insurance most of my life. There was a short period when I didn't. I was completely broke. I feel obligated for that period as well. I wish I had found a way to pay it.

We cannot have the luxury of expensive life saving treatments if we don't make the private insurance system work, which requires all to pitch in. We will lose it and then these discussions will seem like a lost opportunity as we settle for the dreary gray socialist alternative. Make no mistake, in a civilized world it is one or the other .

Balfegor, The only other options are: we not choose to treat him (impossible) or we make someone else pay.

Look at what you're saying there, though. We choose to treat him. We do. Not him. It's our choice. How does our choice impose on him a moral obligation?

You speak of a moral obligation incurred by virtue of choosing to live in a particular society. That might apply with some force for those common goods we have collectively chosen to provide for, like police and military protection. That's part of the deal you accept when you choose to live here (or choose to stay here, rather than move somewhere else). But collective payment of healthcare isn't part of the deal right now. That's what this entire debate is about.

It's one thing for society to change the terms of the deal midway through, and impose a new obligation (e.g. through the proposed health care bill). It's rather a different thing to propose that this obligation exists without there having been any sort of agreement that yes, that obligation is one of the obligations you take on when you choose to live here. That's stealing a base.